Insights

Posted on Wednesday, August 12, 2015 9:47 AM

Some hospices have had claims reporting anti-cancer and anti-emetic drugs returned to the provider (RTP) since the imposition of the requirement to report prescription drugs on hospice claims. CMS and the Medicare Administrative Contractors (MACs) have discovered that this is happening because the Common Working File (CWF) contains an edit that restricts the allowable types of bills on which certain anti-cancer and anti-emetic drugs may be submitted; hospice bills; under current processing rules, may not include these prescription medications. CMS is directing MACs to instruct hospices to remove or omit service lines for oral anti-cancer and anti-emetic drugs from claims so that they can process normally. This action should continue until January 1, 2016, when the edit correction should become effective. Once the edit correction is in place, hospices will be encouraged to submit claims adjustments for all claims that are within the timely filing period to restore the reporting of the oral anti-cancer and anti-emetic drugs so that CMS has accurate data on usage of these medications. Click here to see these instructions posted on the CMS website as Transmittal 1528/Change Request. Click here to read more from NAHC.